Jersey Finger

Definition

Avulsion of the flexor digitorum profundus (FDP) tendon from the base of the distal phalanx.

Mechanism

• Sudden forcible extension of an actively flexed finger.
• Classically occurs in sports such as soccer or rugby, where a player grabs another player’s jersey as they pull away.

Anatomy

• Most commonly occurs in the ring finger (?why).
• The tendon avulses from its attachment to the distal phalanx and may retract proximally towards the PIP joint or even further into the palm.

Clinical Assessment

LOOK

• Swollen finger distally.
• Bruising over distal phalanx and DIP joint.

FEEL

• Maximally tender at base of distal phalanx and DIP joint on volar surface.
• May be tender all along the volar surface of the finger.

MOVE

• Unable to actively flex DIP joint.
• Flexion at PIP and MCP joints preserved.

Imaging

• Finger x-ray to assess for avulsion fracture.
• USS/MRI to assess the degree of tendon retraction.

Radiological Assessment

• The x-ray may be normal or may show evidence of an avulsion fracture.
• Look for an avulsion fracture arising from the FDP insertion site on the volar aspect of the base of the distal phalanx.
• A fleck of bone often retracts proximally with the tendon and may be visualised volar to the PIP joint.

Clinical Cases

Case 1

This 30-year old male presented with pain, swelling and bruising in his distal ring finger after a game of rugby. He gave a history of a sudden “pop” and immediate pain in the finger after grabbing another player’s jersey. On examination he was unable to actively flex his distal phalanx.

Emergency Management

• Analgesia
• Splintage: Apply a POSI splint (position of safe immobilisation) and elevate the limb in a High Arm Sling.

Disposition

• Refer urgently to a hand surgeon.
• The patient will require an open tendon repair within 7-10 days.
• These injuries carry a worse prognosis if not repaired within 7-10 days as the tendon contracts and becomes less viable.

Discharge Advice

• Provide the patient with plaster care advice.
• Ensure they are aware of the need for early surgical repair and hence the need to follow up promptly with the hand surgeon.

Pearls & Pitfalls

• Examining specifically for loss of DIPJ flexion is critical to making this diagnosis.
• Ensure you always isolate FDP and FDS when assessing the patient with a hand injury. Read how to do this here.
• Partial FDP avulsion may present with pain on resisted DIPJ flexion but otherwise preserved FDP function. If uncertain whether a patient has an FDP injury, it is safer to immobilise them in POSI and refer to a hand surgeon.

References

• Dobson P, Taylor R, Dunkin C. Safe splinting in hand surgery. Ann R Coll Surg Engl. 2011 Jan;93(1):94.
• Eddy M. Hands, fingers, thumbs – assessment and management of common hand injuries in general practice. Aust Fam Physician. 2012 Apr;41(4):202-9.
• Bauones S. Clinical Case: Jersey Finger. Radiopedia. 2013
• Bachoura A, Ferikes AJ, Lubahn JD. A review of mallet finger and jersey finger injuries in the athlete. Curr Rev Musculoskelet Med. 2017 Mar;10(1):1-9.
• Emergency Care Institute. MSK Videos: Splinting and Plaster Immobilisation Techniques.

Authors

• Lilian Wong (ED Physiotherapy Practitioner, Sydney)
• Ed Burns (Emergency Physician, Sydney)
• Matt Lutze (ED Nurse Practitioner, Sydney)

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